SVD burden and PA

Pooled TALOS and RESIST data

Andreas Gammelgaard Damsbo

2025-01-13

Intro

  • Small vessel disease (SVD) is a major contributor to stroke and cognitive decline.

  • Hypertension, diabetes, and smoking are well-established contributors to SVD burden, the role of physical activity (PA) is still debated.

  • We aimed to investigate the association of SVD burden, PA and classical risk factors in acute ischemic stroke (AIS) patients.

  • Pooled data from TALOS and RESIST trials

SVD scoring scale

Each feature is summed for a score of 0-4.
Feature Score
Cerebral microbleed 1
Lacune 1
Beginning WMH confluence (Fazeka) 1
Moderate-severe atrophy (GCA) 1

Features 1/2

Features 2/2

Baseline table

Baseline factors
Characteristic Overall
N = 7621
Q1
N = 1911
Q2
N = 1911
Q3
N = 1891
Q4
N = 1911
p-value2
Age 71 (62, 79) 77 (67, 84) 74 (65, 80) 70 (63, 76) 64 (55, 73) <0.001
Female sex 279 (37%) 85 (45%) 89 (47%) 58 (31%) 47 (25%) <0.001
Smoking




0.6
    never 269 (36%) 57 (31%) 75 (40%) 69 (38%) 68 (36%)
    current 211 (28%) 56 (31%) 45 (24%) 53 (29%) 57 (30%)
    prior 262 (35%) 70 (38%) 66 (35%) 62 (34%) 64 (34%)
Hypertension 418 (55%) 123 (65%) 114 (60%) 96 (51%) 85 (45%) <0.001
Diabetes 85 (11%) 27 (14%) 27 (14%) 19 (10%) 12 (6.3%) 0.040
Previous ischemic event 97 (13%) 30 (16%) 24 (13%) 27 (14%) 16 (8.4%) 0.14
SVD score




<0.001
    0 310 (41%) 49 (26%) 72 (38%) 81 (43%) 108 (57%)
    1 195 (26%) 47 (25%) 53 (28%) 42 (22%) 53 (28%)
    2 148 (19%) 54 (28%) 42 (22%) 37 (20%) 15 (7.9%)
    3 73 (9.6%) 30 (16%) 14 (7.3%) 19 (10%) 10 (5.2%)
    4 36 (4.7%) 11 (5.8%) 10 (5.2%) 10 (5.3%) 5 (2.6%)
Admission NIHSS 4.0 (2.0, 7.0) 5.0 (2.0, 9.0) 3.0 (2.0, 8.0) 4.0 (2.0, 8.0) 3.0 (2.0, 5.0) <0.001
1 Median (Q1, Q3); n (%)
2 Kruskal-Wallis rank sum test; Pearson’s Chi-squared test

SVD distribution

[[1]]

Analyses

Ordinal logistic regression

Univariable and multivariable ordinal logistic regression of considered effect modifiers.
Characteristic
Univariable
Multivariable
N OR1 95% CI1 OR1 95% CI1
Age 762 1.09 1.08, 1.11 1.08 1.07, 1.10
Female sex 762 1.19 0.91, 1.55 0.89 0.66, 1.20
Smoking 742



    never
    current
1.01 0.73, 1.41 1.57 1.09, 2.28
    prior
1.69 1.24, 2.32 1.33 0.96, 1.86
Hypertension 761 2.89 2.21, 3.79 1.79 1.33, 2.40
Diabetes 761 1.50 1.00, 2.23 1.35 0.88, 2.08
Previous ischemic event 758 2.57 1.73, 3.81 2.08 1.38, 3.14
Pre-stroke PA quartile 762



    Q4
    Q3
2.04 1.39, 3.00 1.53 1.01, 2.32
    Q2
2.21 1.52, 3.23 1.18 0.78, 1.79
    Q1
3.92 2.69, 5.73 1.78 1.16, 2.73
1 OR = Odds Ratio, CI = Confidence Interval

Adding interaction terms

No adjustment No adjustment PA adjustment PA adjustment PA interaction PA interaction
Characteristic OR 95% CI OR 95% CI OR 95% CI
Smoking
- never
- current 1.63 1.14, 2.34 1.55 1.08, 2.23 1.28 0.62, 2.69
- prior 1.44 1.04, 2.00 1.41 1.02, 1.97 1.76 0.86, 3.64
Hypertension 1.91 1.43, 2.54 1.88 1.41, 2.50 2.12 1.18, 3.83
Diabetes 1.46 0.96, 2.22 1.40 0.92, 2.13 1.81 0.56, 5.38
Previous ischemic event 2.28 1.52, 3.41 2.21 1.48, 3.31 1.47 0.56, 3.73